Quality Review Specialist, Disability Claims

Equitable; Charlotte (NC); On-site; USD 50,000 - 65,000; Full time

Job summary

Join a forward-thinking organization that values diversity and empowers its employees. As a Quality Review Specialist, you'll play a crucial role in enhancing the claims process for Short Term Disability and Paid Leave. This position offers an opportunity to leverage your analytical skills to drive process improvements and develop a comprehensive quality program. You'll collaborate with cross-functional teams to ensure compliance and elevate customer experience. If you are detail-oriented, innovative, and ready to make an impact, this is the perfect opportunity for you to grow your career while contributing to a meaningful cause.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Plan

Paid Time Off

Performance Bonuses

Qualifications

• 3+ years of experience in the insurance industry required.
• Strong analytical skills and attention to detail are essential.

Responsibilities

• Conduct quality reviews of claims to ensure compliance with regulations.
• Collaborate with teams to improve processes and customer experience.

Skills

Claims Management

Effective Communications

Information Analysis and Interpretation

Analytical Skills

Problem-Solving Skills

Tools

FINEOS Claims software

Job description

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential?

Equitable is seeking detail-oriented and experienced Quality Review Specialist to join our Disability and Paid Leave Claims organization. The Quality Review Specialist is responsible for the equality review of Short Term Disability and Paid Leave claim processing. Ideal candidates will have a creative mindset for developing and operating a Quality Program with a lens on the customer experience.

Key Job Responsibilities

1. Quality Assurance:
   1. Conduct thorough reviews of Paid Leave and Short Term Disability claims to ensure compliance with internal, state and regulatory requirements.
   2. Share feedback with a coaching mindset with a focus on talent development and continuous improvement.
2. Process Improvement:
   1. Collaborate with cross-functional teams to identify opportunities for improvement in current processes.
   2. Stay updated on changes in insurance regulations and industry best practices.
   3. Partner with teams to develop innovative solutions to elevate outcomes and customer experience.
3. Program Development:
   1. Assist in establishing and building a comprehensive quality program tailored to the needs of our organization.
4. Technical Expertise:
   1. Apply technical knowledge to evaluate and enhance the effectiveness of Short Term Disability and Paid Leave programs.
5. Data Analysis:
   1. Analyze data and generate reports to track performance metrics and identify emerging trends or opportunities.

The base salary range for this position is $50,000 - $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.

Equitable Pay and Benefits : Equitable Total Rewards Program

Required Qualifications

1. 3+ years of experience in the insurance industry
2. Professional work experience with Group Insurance Short Term Disability and Paid/Unpaid Leaves claims management

Preferred Qualifications

1. Prior experience with Group Insurance Claims Quality Review, is beneficial
2. Strong analytical skills with excellent attention to detail
3. Experience with Intake and Onboarding functions is a plus
4. Strong verbal, written communication, and presentation skills
5. Ability to think creatively and propose innovative solutions for Quality Program development and continuous improvement
6. Comfortable dealing with complexity and ambiguity and able to explore multiple solutions
7. Previous experience with FINEOS Claims software platform

Skills

Claims Management: Comprehensive understanding of insurance policies, coverage terms, medical classification and claims adjudication procedures.

Effective Communications: Excellent written and verbal communication to effectively convey information to diverse audiences including legal professionals, policy holders and internal stakeholders.

Information Analysis and Interpretation: Ability to critically evaluate complex medical records, policy language to make informed insight on claims management and strategy. Strong analytical and problem-solving skills. Maintain accurate records of all cases in system of record.

ABOUT EQUITABLE

At Equitable, we’re a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose.

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Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.

NOTE: Equitable participates in the E-Verify program.

If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at [phone] or email us at [e-mail].